Last week I felt assaulted: not on the street, nor in a dark parking structure, alley or another risky location. Instead, this feeling of having been assaulted happened to me in a hospital.
It happened during a routine screening mammogram.
When I was 32 years old, after more than a year of misdiagnoses, a different doctor than the first ordered a mammogram that saved my life. For years after undergoing experimental radical radiation treatment, I would come to tears during a mammogram. Some of it was pain from the pressure of the test on my scarred breast tissue. Some of it was my fear of being told: "The cancer has recurred."
Today, I'm a veteran of mammograms. I receive them annually. And I will have one again next year. I believe that women should not hesitate to have their first screening mammograms, and then regular ones thereafter as recommended by reputable guidelines and in consultation with their doctors about their level of risk.
That being said, I'm angry! While I waited for my mammogram last week, another woman in her 50s joined me in the waiting room. Clad in a floral cotton mammography shawl, she was trying not to cry. She'd just completed her mammogram and was waiting to hear if another view would be needed. I commiserated with her about the chilly air conditioning in the waiting room and I smiled, hoping to provide distraction or encourage her to share what was going on emotionally for her. She smiled back, but it was plain something was wrong.
A technician appeared in the doorway.
"We need one more," she said indifferently to my companion. "Come with me."
Then the technician vanished, leaving the woman again distraught.
"Is that technician blind?" I thought to myself "Couldn't she have waited for a moment? Walked with this patient to the exam room? Said, 'It will be quick' or simply smiled reassuringly?"
Yet here this poor woman was trembling, treated like a person standing in line at a crowded Manhattan pizza stand.
In my experience, if you need an MRI the radiologists act as if they can't do enough for you: music of your choice, some gentle words, a tap on the knee, and a call button to use at any time, for any reason. Yet here's a test that is also scary at best, quite painful for many women, and the message this tearful woman got was the equivalent of "Next! Come on! Woman up!"
As she rose reluctantly, she glanced at me and acknowledged my encouragement. Her lips tightened, clearly disappointed, she trudged out of the waiting room for another "view" -- a euphemism for what she would experience. Minutes later she returned, weak and short of breath. Her face was ashen, her eyes red. She went into the changing room, closed the colorful, flowery curtain (chosen, no doubt, to make us all feel better), and then cried softly.
As I thought about whether I should interrupt this woman and try to talk with her some more, the technician called me for my mammogram. I waited a moment; my waiting room companion's crying had subsided. "Maybe it isn't my business," I thought, But surely it was someone's.
The technician didn't walk with me, as several others had done in years past, smiling and endeavoring to relax me. No, she was gone, and I wandered the hallway to find the right room. There was no time for small talk, just a few questions about my history and then we got started - my birthdate, doctor's name and my own. Missing was a gentle touch on my shoulder as some technicians had ventured in previous years. Absent was any assurance that "This won't take long" or "Tell me right away if this hurts too much."
While I like efficiency when having my car serviced or ordering lunch on a short break, I decided this technician could use some guidance. "There's a lot of scarring on my right side from radical radiation, so you'll want to move slowly," I said. She may have nodded, but nothing was said.
She placed my arm across the machine then grabbed my right (radiated) breast, poked, stretched, squeezed and pressed without hesitation. The clear acrylic pressure plate descended, without hesitation, until pain tore through my breast and into my shoulder. Then down a bit more. "Don't breathe," she said, stepping behind the radiation barrier.
At last, the monster released me.
After the first invasion, I was seeing stars. I stepped back from the machine and breathed deeply. At least it would be over soon - this was the short, screening mammogram. Had it been a longer diagnostic one, she and I would have had to exchange words.
But she was nothing if not quick.
"Step over here; place your arm like this; move closer to the machine" she ordered before again grabbing my unscarred left breast in the same manner as she had on the right. I made it through.
"One more on the right," she said.
"Oh God," my brain protested.
I braced myself, stepped forward, she positioned me, lowered the pressure plate rapidly rather than gently as others had so proficiently done in the past. I yelped in pain. She uttered something that may have been "sorry" but sounded more like, "Oh." She did not release me from my prison of pain nor ask if I'd like to step back. She continued: the pressure was made more intense. "Just let it be over."
"Don't breathe," she said stepping behind the radiation barrier. For several long, long seconds I hung there, up on my toes, feeling as if I would surely faint. And I'm no shrinking violet.
No good wishes passed between us as I left the room, walked unsteadily back to the waiting room, and sat to wait as the woman had before me, to find out if another 'view' was necessary. "If so," I thought, "another technician will have to do it this time." But I was dismissed - one of the lucky ones. Tears welled in my eyes for the first time in years. Maybe they were for me, but I suspect for the woman before me too.
Now, I'm a big believer that a little discomfort (even a lot sometimes) is better than a poorly performed medical test. For many women, mammography is not very painful. Yet, there is nothing about the test itself that makes consideration and competence mutually exclusive.
Mammography, as is common with MRIs, should be done with compassion. "Would you like to rest between views?" and "We have one more to do. How are you feeling?" are the kinds of questions mammography patients need to hear.
Imagine if you will that, without warning or tenderness, someone grabs, stretches, pushes and squeezes a man's testicles between two plates for a medical test. Obviously, the very thought is appalling. It would be inhumane. And so is any such treatment with mammogram patients.
The next time you go for a mammogram (or go with someone you love), observe the behavior at the reception desk and the body language of the technician. Is everyone just trying to get to lunch hour or beat the traffic? How is emotional expression dealt with in the waiting room? If the technician shows no interest in your concerns, insist that she does so. Let her know if a breast is sensitive -- and how she can help you endure the discomfort. If she isn't receptive -- ask for a different technician. If you've been treated like I was, then when it's over (though preferably before) tell the person in charge and inform your doctor, as I did, so that other women won't suffer from indifference or incompetence.
You are the customer. Sure you're fearful, and that's a big part of the reason why most of us don't think to insist on a best practices mammogram. Many women I've talked with consider mammography pain as something they must tolerate for a greater good. To some extent and for many women, that's true. But there is absolutely no reason why you should feel that you as an individual have been ignored and your pain belittled. No one should be trembling as they leave, feeling violated and fearful of the next mammogram they must endure.
A mammography unit that won't do its best to make you comfortable shouldn't be in business. You wouldn't normally volunteer for a colonoscopy where they had run out of anesthetic -- so why volunteer to be abused during a mammogram because they don't train their technicians properly?
Why not say?
"You're moving too quickly for me."
"I need to rest a moment between views."
"I'd appreciate a little more sensitivity."
"Clearly you underestimate my discomfort."
"We'll have to stop if you can't adapt your style to accommodate my pain."
If you like the way a previous mammogram was done, ask for that technician again, and avoid problems before they start. Just don't convince yourself that nothing can be done about the pain. It can. And like so much in medical care, assuring you get the best means refusing to accept anything less.